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Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381)

IC 7932 under ICR 202406-0938-004 · OMB 0938-0273.

Documents and Forms
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Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
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Information Collection (IC) Details

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Identification of Extension Units of Outpatient Physical Therapy/Outpatient Speech Pathology Providers and Support Regs. (CMS-381)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 485.701-485.729

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-381 REQUEST FOR CERTIFICATION IN THE MEDICARE AND/OR MEDICAID PROGRAM TO PROVIDE OUTPATIENT PHYSICAL THERAPY (OPT) AND/OR SPEECH PATHOLOGY SERVICES (OSP)- INITIAL AND EXTENSION SITE REQUESTS Combined Form CMS-1856 and CMS-381 (Final).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

506 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 506 0 63 0 0 443
Annual IC Time Burden (Hours) 253 0 142 0 0 111
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Tracked changes Combined Form CMS-1856 and CMS-381 (Crosswalked).docx 06/12/2024
Crosswalk Crosswalk for Reviewers.docx 06/12/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.